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Results for “Splenectomy”

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PubMed2006

Palliative goals, patient selection, and perioperative platelet management: outcomes and lessons from 3 decades of splenectomy for myelofibrosis with myeloid metaplasia at the Mayo Clinic.

BACKGROUND: Although splenectomy may palliate massive splenomegaly in patients with myelofibrosis with myeloid metaplasia, this procedure carries significant risks. The authors retrospectively analyzed their experience with splenectomy over the course of 30 years to analyze the impact of improved techniques, antimicrobials, and aggressive postoperative control of platelet counts on outcome. METHODS: A total of 314 patients underwent splenectomy between 1976 and 2004 for mechanical symptoms (= 156 patients [49%]), anemia (= 78 patients [25%]), portal hypertension (= 47 patients [15%]), or thrombocytopenia (= 33 patients [11%]). Of a total of 91 patients studied during the last decade, 69 patients (76%) experienced a palliative benefit for their primary surgical indication for a median of 12 months (range, 1-91 months). RESULTS: Perioperative complications occurred in 87 patients (27.7%) including infection (= 31 patients [9.9%]), thrombosis (= 31 patients [9.9%]), or bleeding (= 44 patients [14%]), 21 of which (6.7% of all patients) were fatal. Perioperative thrombohemorrhagic complications decreased in the last decade through the use of platelet apheresis and the prompt use of cytoreductive agents to counteract postsplenectomy thrombocytosis. Survival after splenectomy was found to be decreased in patients with preoperative thrombocytopenia (<100 x 10(9)/L [P = 0.006]) but not by indication, myelofibrosis with myeloid metaplasia (MMM) prognostic score, or the decade in which splenectomy was performed. CONCLUSIONS: The lack of improvement in overall postsplenectomy survival over time may be a reflection on the failure of medical therapy to improve survival in patients with MMM.

Adolescent↗

PubMed1994

[Splenectomy--a strictly aseptic intervention?].

To determine the factors causing wound infections after splenectomy, 211 patients undergoing surgery during 1982-1991 were studied in two groups:--Patients with clean-contaminated or contaminated operations with additional splenectomy in the same session;--Patients with elective splenectomy only. While in the first group the rate of disorders of wound healing (DWH) was 31.6%, the second group had a rate of 8.15%. This rate was higher than for other clean operations in our hospital and was as high as for clean-contaminated operations such as cholecystectomy. Among the patients older than 60 years, 38.2% had DWH, as against 8.9% of the patients younger than 60 years. The mean operating time in patients with wound infections was 223 min, while the mean operating time in patients without infections was 125 min. In patients with wound infections the gamma-GT was higher than in patients who had no infection. After these results we have given 2 g ceftriaxon as single-shot prophylaxis before every splenectomy. Since starting this, we have performed 28 splenectomies, and DWH has been observed in only 1 (3.57%). We therefore recommend antibiotic prophylaxis.

Adolescent↗

PubMed1987

Transient improvement of polymorphonuclear leukocyte function by splenectomy in beta-thalassemia.

Host defense mechanisms in transfusion-dependent non-splenectomized patients with beta-thalassemia were studied. Polymorphonuclear leukocytes (PMNLs) of non-splenectomized patients responded poorly to zymosan generated chemotactic factors. Chemotactic indices were 22.1 microns +/- 2.8 (mean +/- S.D.) using zymosan activated serum (ZAS) as the attractant in comparison to 20.4 microns +/- 2.6 when fresh untreated serum was used. In contrast, chemotactic indices of normal PMNLs increased from 21.1 microns to 33.6 microns +/- 3.1 in response to ZAS. Normal PMNL responses to a mixture of normal ZAS and thalassemic serum were inhibited; the mean chemotactic index was 18.1 microns +/- 5.1 with use of ZAS alone. Splenectomy temporarily reverses these alterations. Adherence to nylon wool of PMNLs suspended in fresh thalassemic serum prior to splenectomy was 3.1% +/- 1.1 (mean +/- S.D.); 20 days after splenectomy adherence increased to 14.0% +/- 2.8 (P = 0.0001) and remained at this level for 90 days. At 120 and 150 days after splenectomy adherence decreased to 1.5% +/- 0.8 and 1.0% +/- 0.85 respectively. Splenectomy also transiently abrogated the failure of zymosan to generate chemotactic factors in thalassemic serum.

Adolescent↗

PubMedDate not supplied

Splenectomy for treatment of gastric cancer: Japanese experience.

Surgery for gastric cancer in Japan has frequently been combined with resection of the spleen (splenectomy) or of the pancreatic body and tail and spleen (pancreatosplenectomy, PS). Splenectomy in patients with gastric cancer has been performed with two major purposes in mind: (1) curability of the cancer and (2) immunologic reasons. Direct cancerous invasion to the pancreas requires PS, although examination of these cases revealed that in 34.3% of such macroscopic invasions only fibrous adhesion to pancreas existed. Metastases to lymph nodes at the splenic hilus (no. 10) or along the splenic artery (no. 11) also required splenectomy. The incidences of no. 10 or no. 11 lymph node metastasis were as high as 26.7% and 22.2% respectively, for cancers of whole stomach, and 15.5% and 12.1% for cancers of the upper portion of stomach. Concerning the immunologic aspect of splenectomy for gastric cancer, the reports of fundamental research and clinical studies suggest that the spleen plays sometimes acts as a suppressor and at other times as a helper to the tumor activity, according to the number of tumor cells. From these data, we concluded that the spleen should be preserved in stage I, II, and III patients with curative operation; for stage IV patients the spleen should be resected. The immunologic significance of splenectomy should be clarified precisely in the near future.

Humans↗

PubMed1997

Pediatric laparoscopic splenectomy: are there real advantages in comparison with the traditional open approach?

The hospital records of patients who underwent splenectomy during the last 2 years were reviewed to compare the advantages of the laparoscopic approach with traditional open splenectomy (OS). Between March 1994 and March 1996, 16 children underwent splenectomy, in 8 using an open approach and 8 by a laparoscopic procedure. Of the patients who underwent laparoscopic splenectomy (LS), 2 had a concomitant cholecystectomy. Ages ranged between 4 and 11 years (mean 6.4 years); there were 9 girls and 7 boys. The indications for splenectomy were: hereditary spherocytosis (7 cases); idiopathic thrombocytopenic purpura (4); sickle-cell disease (3); and beta-thalassemia (2). The average operating time for OS was 100 min (range, 50-155), for LS 170 min (range 125-240). The hospital stay for patients who had OS ranged from 3 to 9 days (mean 4.7), for those who had LS from 2 to 5 days (mean 3). One OS patient developed a wound infection. In 3 of the LS patients, the spleen was removed via a 7-cm Pfannenstiel minilaparotomy in the suprapubic region; in 5 cases the spleen was captured into an extraction bag, crushed, and removed through the umbilical orifice. The authors believe that LS must be performed only when it is possible to use the extraction bag to remove the spleen from the umbilical orifice (spleens weighing less than 700 g) and when a concomitant procedure such as cholecystectomy is indicated; in other cases OS is preferable.

Child↗

PubMedDate not supplied

Laparoscopic splenectomy.

Splenectomy has traditionally been done through a generous laparotomy incision, requiring complete mobilization of the spleen for removal. In selected cases, however, splenectomy may either be facilitated or performed entirely by laparoscopic means. Two patients with Hodgkin's disease in whom splenectomy was facilitated laparoscopically are described; in another patient with idiopathic thrombocytopenic purpura (ITP), the splenectomy was successfully performed through the trocar incisions. In selected cases, laparoscopic splenectomy is feasible, provided the laparoscopist is expert in advanced techniques of intraabdominal endoscopic surgery.

Adult↗

PubMed2003

Scintigraphic prediction of therapeutic outcomes of splenectomy in patients with thrombocytopenia.

UNLABELLED: In patients with thrombocytopenia, platelet scintigraphy has been used to locate the site of platelet sequestration and destruction and to determine whether splenectomy will be of benefit. However, its efficacy in predicting the outcome of splenectomy is controversial. We assessed the feasibility of platelet scintigraphy in this regard. METHODS: Platelet scintigraphy was performed in five patients (2 women, 3 men, mean age 48 years) before splenectomy. Four patients were diagnosed with idiopathic thrombocytopenic purpura and one with hypersplenism due to portal hypertension caused by intrahepatic chemotherapy against metastatic liver tumors of rectal cancer. Platelets labeled with 37 MBq of In-111 oxine or 1110 MBq of Tc-99m HMPAO were intravenously injected. Anterior images were obtained with a gamma camera 3-5 and 23-29 hours post-injection in five patients. Additional images were obtained 48 hours post-injection in three patients. For the analysis, a spleen/liver ratio (S/L ratio) was calculated using mean counts in regions of interest defined on the spleen and the liver. Serum platelet counts were measured before and after the operation; in three patients, splenectomy effectively resolved the thrombocytopenia (Group A), while it was ineffective in two patients (Group B). RESULTS: The S/L ratios were apparently higher in Group A than in Group B; in Group A, the ratios were 6.05, 6.97 and 3.16 at 3-5 hours, 12.67, 7.48 and 3.46 at 23-29 hours and 17.66 and 8.12 at 48 hours, whereas, in Group B, they were 0.67 and 0.66 at 3-5 hours, 0.52 and 0.54 at 24 hours, and 0.42 at 48 hours. CONCLUSION: The results of this study indicate that platelet scintigraphy is of value in predicting the therapeutic efficacy of splenectomy in patients with thrombocytopenia.

Adult↗

PubMed1999

Laparoscopic splenectomy.

Splenectomy is a powerful tool for treatment of hematologic disease, with 70% to 90% of patients achieving long-term improvement. In recent years laparoscopic splenectomy has gained acceptance as a viable alternative to open splenectomy. This review summarizes the indications for laparoscopic splenectomy, the operative techniques, and the most recent results. Laparoscopic splenectomy is evolving and may become the standard operative method for the treatment of the problem spleen.

Follow-Up Studies↗

PubMed2005

Cardiovascular effects of splenomegaly and splenectomy in beta-thalassemia.

Splenomegaly is common in beta-thalassemia, bearing some particular hemodynamic features, while splenectomy is an established therapeutic intervention in these patients. Their effects, however, on systemic hemodynamics and thalassemia heart disease have not yet been assessed. The study included 32 consecutive patients, 13 with thalassemia major (TM) and 19 with thalassemia intermedia (TI), aged 23.4+/-4.2 years, requiring splenectomy. Assessment was performed before and 6 months after splenectomy and included hematological profile and resting echocardiography; total blood volume was also measured in 10 of 32 cases. Preoperative echocardiographic data were compared with those of 34 controls. Preoperative left ventricular diameters and mass, cardiac index, and systolic pulmonary artery pressure were all significantly higher in patients compared to controls (p<0.001), but did not differ significantly between TM and TI patients. Postoperatively, the mean hemoglobin level increased from 8.1+/-0.6 to 9.1+/-0.4 g/dl (p<0.001), total blood volume index declined from 2847+/-332 to 2310+/-276 ml/m(2) (p<0.001), blood transfusions were discontinued in 80% of TI patients and mean 6-monthly transfusion requirements in TM patients were reduced from 28+/-5 to 22+/-4 units (p<0.001). However, cardiac parameters were not significantly modified. It seems that left ventricular remodeling, high output state, and increased pulmonary artery pressure characterize both TM and TI patients who require splenectomy. Although these abnormalities remain unchanged after splenectomy, the removal of the spleen may contribute to the prevention of further cardiac damage by ameliorating the patients' hematological status and reducing their transfusion needs.

Adult↗

PubMed2003

Should cholecystectomy be performed concomitantly with splenectomy in children with sickle-cell disease?

Splenectomy and cholecystectomy are among the common surgical procedures required to treat complications of sickle-cell disease (SCD), and when performed separately have been shown to be safe and effective. To determine whether cholecystectomy be performed concomitantly with splenectomy (CSC) in these children, we studied a total of 130 children who underwent splenectomy for various hematologic diseases at our hospital. The most common indication was SCD. Ninety-nine patients (86 SCD and 13 sickle-B-thalassemia) underwent splenectomy and 19 (19.2%) (12 males and 7 females, mean age 13.4 years [7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]) underwent CSC due to concomitant gallstones, which were asymptomatic in 13 cases. Those with an admission hemoglobin (Hb) of less than 10 g/dl were transfused with packed erythrocytes to increase their Hb to 10-12 g/dl and their hematocrit to 30%-40%. All patients received intravenous hydration the night before surgery at a rate of 1(1/2) times their maintenance rate, which was continued postoperatively until they were able to tolerate adequate oral fluid intake. The indications for splenectomy in those who had CSC were: acute splenic sequestration crisis in 12, splenic abscess in 3, hypersplenism in 2, and massive splenic infarction in 2. Eight patients had massive splenomegaly (spleen weight >1 kg). In 7 cases CSC was done through a left-upper-quadrant (LUQ) transverse incision, in the remaining 12 through an upper midline incision. There was no mortality and only 2 patients developed postoperative complications; a wound infection in 1 and a hematoma in the splenic bed in another. With good perioperative management, CSC is both safe and effective for children with SCD. Both procedures can be performed safely through an upper midline or a LUQ transverse incision, even in the presence of massive splenomegaly.

Adolescent↗

PubMed2003

Pediatric laparoscopic splenectomy: benefits of the anterior approach.

INTRODUCTION: Splenectomy is frequently performed in children for various hematologic and autoimmune disorders. We reviewed our indication for splenectomy, our technique of laparoscopic, splenectomy, and our results. The aim of this study was to show if an anterior approach with elective vessel endoligature in a patient in decubitus position was a better and safer approach than the other techniques previously published. PATIENTS AND METHODS: Between January 1996 and December 2002, 54 children underwent laparoscopic splenectomy. We use the anterior pedicle approach and elective vessel endoligature in order to prevent persistence of any exogenous material. Sixteen children also had a concomitant cholecystectomy. Their age ranged between 1 and 18 years (mean 7.5 years). Twenty children had hereditary spherocytosis, 15 were affected by sickle cell disease, six had an idiopathic thrombocytopenia, four had beta-thalassemia, and nine another hemolytic disease. RESULTS: Mean operative time was 150 min (range, 115-230 min). Hospital stays ranged from 3 to 15 days (mean: 5.4). Seven patients had complications (four pneumonia and three deep abscess with successful antibiotic treatment). Median follow-up was 42 months (2 months-6 years) without problems regarding procedure. DISCUSSION: With this technique consisting in first elective arterial and secondary venal ligature, we preserved blood splenic sequestration and pancreatic tail lesion. The procedure is safer. For us, considering the low complication rate for this type of patient, and the advantages of a small abdominal trauma in the postoperative period, laparoscopy with anterior approach for elective splenectomy and eventual cholecystectomy in hematologic disorders is the best technique.

Abdominal Abscess↗

PubMed2005

Splenic artery embolization before laparoscopic splenectomy in children.

BACKGROUND: This study assessed the safety and utility of preoperative splenic artery embolization before laparoscopic splenectomy in children. METHODS: Five young girls with a mean age of 13.2 years underwent laparoscopic splenectomies at the authors' institution from August 1998 to April 2003. Three of the patients had idiopathic thrombocytopenic purpura, and two had hereditary spherocytosis. Preoperative splenic artery embolization was performed the day before the surgery in all cases. The laparoscopic splenectomy was performed using traditional laparoscopic procedures and standard laparoscopic instruments with the patient in the right semilateral position. RESULTS: The mean spleen weight was 252.6 g, and the mean length was 11.6 cm. All the patients reported postembolic pain, but not to a level unmanageable by intravascular narcotics. There were no severe complications in the splenic artery embolization. The laparoscopic splenectomies were completed in a mean of 211 min, with a mean estimated blood loss of 9 ml. None of the operations required conversion to traditional open laparotomy, and none of the patients died or experienced operative complications. CONCLUSION: The authors concluded that splenic artery embolization is safe and useful as an adjuvant procedure performed before elective laparoscopic splenectomy in children.

Adolescent↗

PubMed2006

Impact of morbid obesity on outcome of laparoscopic splenectomy.

BACKGROUND: Because of the obesity epidemic, surgeons are operating on morbidly obese patients in increasing numbers. The aim of this study was to evaluate the impact of morbid obesity on the outcome of laparoscopic splenectomy. METHODS: The study group consisted of 120 consecutive patients who underwent laparoscopic splenectomy for benign and malignant disease from March 1996 to May 2005. These patients were retrospectively divided into three groups. Group 1 had a body mass index (BMI) < 30. Group 2 patients had a BMI > or = 30 and < 40 and were considered obese. Group 3 had a BMI > or = 40 and were considered morbidly obese. Data including surgical approach (laparoscopic vs. hand-assisted), operative time, conversion rate, estimated blood loss, splenic weight, length of stay, time to tolerate a diet, pathologic diagnosis, complications, and mortality were recorded. RESULTS: Complete data were available for evaluation of 112 patients of whom 73 (65%) had a BMI < 30, 32 (29%) had a BMI > or = 30 and < 40, and 7 (6%) had a BMI > or = 40. The most frequent indication for splenectomy in all three groups was idiopathic thrombocytopenic purpura (ITP). The operative times were significantly higher in patients with a BMI > 40. Conversion rates were also higher in this group, although this did not reach statistical significance. Patients with a BMI > 30 experienced similar complication rates when compared with patients with a BMI < 30. Only when patients had a BMI > 40 did they experience more complications. CONCLUSIONS: Laparoscopic splenectomy was performed safely in obese patients (BMI > 30) with similar results to those of nonobese patients. Only in morbidly obese patients (BMI > 40) do outcomes and complications appear to be affected. Obesity should not be a contraindication to laparoscopic splenectomy.

Adult↗

PubMed2000

Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura and hemolytic anemia.

BACKGROUND: Laparoscopic splenectomy is an effective treatment for idiopathic thrombocytopenic purpura (ITP) and hemolytic anemia that has a remission rate of 80-90%. In some patients in whom the disease persists or recurs, a diagnosis of accessory spleen is made. The long-term efficacy of laparoscopic accessory splenectomy is unknown. METHODS: Patients who underwent laparoscopic accessory splenectomy were followed in the outpatient clinic. The perioperative course, blood counts, and need for medical therapy to maintain a normal count were recorded. RESULTS: Eight patients underwent laparoscopic accessory splenectomy. All procedures were completed laparoscopically, and all patients were discharged on the 1st postoperative day. Patients were available for a follow-up period of 15 months range, (3-27). None of the ITP patients achieved a complete remission. Two of them had a partial remission, and five ITP patients are now being treated with chronic corticosteroids to maintain a platelet count of >100,000/ml. CONCLUSION: Laparoscopic accessory splenectomy is associated with a low rate of morbidity and a short hospital stay. Despite its success in removing all residual splenic tissue, most patients will probably not enjoy a complete remission.

Adrenal Cortex Hormones↗

PubMed2000

A new surgical strategy for cirrhotic patients with hepatocellular carcinoma and hypersplenism. Performing a hepatectomy after a laparoscopic splenectomy.

BACKGROUND: Hepatectomy for cirrhotic patients with hypersplenism is a high-risk operative procedure. We report herein a new strategy for high-risk patients with hepatocellular carcinoma (HCC). METHODS: Six cirrhotic patients with HCC and hypersplenism received a partial hepatectomy after first undergoing a laparoscopic splenectomy. We then compared the variables for these patients before splenectomy and before hepatectomy. RESULTS: The platelet count and the white blood cell count were found to be significantly elevated before hepatectomy. The ammonia value decreased significantly before hepatectomy. The albumin value tended to be elevated before hepatectomy. Furthermore, the Child's classification of all patients improved significantly before hepatectomy. However, other variables-such as the indocyanine green dye excretion test at 15 min and the bilirubin value-did not change after splenectomy. For hepatectomy patients who first underwent a laparoscopic splenectomy, operation time ranged from 265 to 440 min (average time, 361 min), and blood loss ranged from 500 to 2,200 ml (median volume, 1,300 ml). Four of six patients did not require any blood transfusion; furthermore, no patient needed a platelet-rich plasma transfusion. All but one patient, who suffered postoperatively from an intractable duodenal ulcer, had an uneventful postoperative course. CONCLUSION: Partial hepatectomy after an initial laparoscopic splenectomy is a new and effective choice of treatment for cirrhotic patients with HCC and hypersplenism.

Aged↗

PubMed1997

Laparoscopic splenectomy. The emerging standard.

BACKGROUND: The purpose of this study was to evaluate the outcome of patients undergoing laparoscopic splenectomy (LS) at the University of California, San Francisco. METHODS: The medical records of the initial 52 unselected patients undergoing LS were reviewed and compared to 28 concurrently treated open splenectomy patients (OS). RESULTS: Patients did not differ with regard to age, gender, body, or splenic weights. The operative time was longer in the LS patients (mean 196 vs 156 min), but the length of stay and duration of ileus were shorter in the LS group. For adult patients admitted exclusively for splenectomy, operative times did not differ between LS and OS and total hospital cost was less in the LS group (mean $8, 939 vs $14,022). Six patients required conversion to OS, four occurring in the first 11 patients treated (overall conversion rate of 11%). Three patients died from complications related to their underlying disease. Two other major complications occurred. Complication rates and transfusion requirements did not differ between OS and LS patients. CONCLUSIONS: Laparoscopic splenectomy is a safe and effective alternative to open splenectomy for treatment of hematologic diseases in patients of all ages.

Adolescent↗

PubMed1997

Laparoscopic splenectomy in a Jehovah's Witness with profound anemia.

Open surgery in a severely anemic patient may be complicated by a substantial blood loss from a large incision and subsequent poor wound healing secondary to the anemia. We report our success in performing a splenectomy laparoscopically in a profoundly anemic patient. A 50-year-old white male Jehovah's Witness who was HIV positive was referred for splenectomy after he developed profound, worsening anemia secondary to hypersplenism that was refractory to medical management. His preoperative hemoglobin and hematocrit levels were 2.7 g/dl and 8.8%, respectively, but his religious beliefs precluded transfusion. A laparoscopic splenectomy by the posterior gastric approach was performed. The patient tolerated the surgery well and experienced no additional morbidity. On postoperative day 7, his hemoglobin and hematocrit were 6.8 g/dl and 22%, respectively. We conclude that laparoscopic splenectomy is an attractive procedure in a severely anemic patient who requires splenectomy and refuses blood transfusion.

Anemia↗

PubMed1998

Laparoscopically assisted massive splenectomy. A preliminary report of the technique of early hilar devascularization.

Laparoscopic splenectomy has been safely performed for small spleens, but technical limitations have prevented massive splenectomy. We describe a technique of early hilar devascularization to enable massive splenectomy in three patients over the age of 80 years. Massive splenectomy was performed with minimal blood loss and minor morbidity. Early laparoscopic control of the splenic artery and vein will enable the safe removal of the massive spleen, without major laparotomy. Morbidity of splenectomy may be reduced by laparoscopy.

Aged↗